Septal Myectomy in Pediatric Obstructive Hypertrophic Cardiomyopathy: A Systematic Review and Meta-analysis.

Evidence regarding outcomes of septal myectomy in pediatric patients with obstructive hypertrophic cardiomyopathy (HOCM) remains limited. This meta-analysis aimed to assess surgical outcomes and long-term survival in this population. A systematic review was conducted using PubMed, Embase, Scopus, and Cochrane databases to identify studies evaluating septal myectomy in pediatric patients with obstructive HCM. Eight clinical trials comprising a total of 490 pediatric patients met the inclusion criteria. Among children undergoing septal myectomy for HOCM, the pooled early and late mortality rates were 3.3% and 8.5%, respectively. Concomitant mitral valve repair was performed in 7.3% of patients. Rates of complete atrioventricular block and permanent pacemaker implantation were 9.9% and 5.1%, respectively. The mean durations of intensive care and hospital stay were 34.6 h and 12.9 days. Postoperative wound infection and reoperation occurred in 3.4% and 6.4% of cases. Echocardiographic assessments demonstrated a marked reduction in LVOT gradient (from 86.9 to 16.2 mmHg) with preserved left ventricular ejection fraction. Mitral regurgitation decreased from 49.8 to 6.4%, and systolic anterior motion from 84.9 to 19.9%. Septal myectomy in pediatric patients with HOCM is a safe and effective procedure, associated with favorable survival and substantial symptomatic and hemodynamic improvement. However, results must be interpreted cautiously due to moderate-quality retrospective data.